Saudi Stroke Standards

EMS transfer Purpose To improve EMS transfer of stroke patients in terms of speed of response, consistency of assessment and intervention and conveyance to the appropriate facility in a timely manner. Rationale  Stroke is a major emergency seen in prehospital care. EMS stroke performance indicators have not been established. This document is designed to standardize the care and EMS response to all stroke patients.  Urgent detection and treatment of stroke is crucial to the final outcomes. Typically, 1.9 million neurons are lost for each minute a stroke goes untreated.  The first steps to accessing emergency treatment is a rapid response to an EMS call or ED conveyance for suspected acute stroke; rapid assessment utilizing a pre- hospital assessment tool (e.g. FAST) by the ambulance crew and emergency transfer with pre-alert to a receiving hospital able to offer hyper-acute services with appropriate 24-hour expertise for all those who are likely to benefit from immediate treatment, including intravenous thrombolysis. 6 Ibid 7 Rothwell PM, et al., 2007, ‘Effect of urgent treatment of transient ischemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison’, Lancet 370, 1432–  Ambulance services should work on proposals for improving the ability of ambulance medical dispatch systems to determine stroke calls that meet the FAST criteria and allow ambulance control staff to make a more appropriate response, which might be a category A response, within 15 minutes, where indicated.  Thrombolysis for treatment of stroke must be started as soon as possible and within 4 ½ hours of the onset of the stroke symptoms at the latest and after prior exclusion of intracranial hemorrhage by means of appropriate imaging techniques.  For ischemic stroke patient’s thrombolysis can be an effective treatment where it can be delivered within 4 ½ hours; the patient should be triaged to a hospital which can deliver the drug. If the 4 ½ hour window has passed, it may be more appropriate to transfer to the nearest hospital with an acute stroke unit. (This time window may change as the evidence base increases.) Standards 1. All stroke patients are recommended to be transferred via the EMS system. 2. EMS dispatchers should make stroke a priority, dispatch and transport times should be minimized. 3. EMS personnel should provide prehospital notification to the receiving hospital that a suspected stroke patient is on-route so that the appropriate hospital resource is mobilized prior to the patient arrival. 4. Stroke patients should be attended by the highest level of care available (If highest level of care will delay response, available EMS unit should be dispatched). 5. EMS response time should be < 15 minutes, and ambulance response should be code 1 (with lights and sirens). 6. EMS scene time should be ≤ 10 minutes. 7. EMS personnel must use a validated tool to detect stroke patients (i.e. FAST). 8. EMS should evaluate for the presence of stroke mimics a. Hypoglycemia b. Seizure c. Sepsis d. Migraine e. Intoxication 9. EMS unit should bypass acute stroke ready hospitals if a Primary Stroke Hospital or Comprehensive Stroke Hospital is available within 45 minutes or 60 km. QM 4.2 Emergency Stroke Assessment and Care QM